Two weeks ago I donated a kidney to a person I have never and will never meet.
A fortnight ago was the culmination of a year long process based at the Royal Free Hospital, one of the busiest transplant centres in Britain. Non-directed donation has been a small but growing phenomenon since it was legalised 10 years ago; at the Royal Free they do around 2 a year, and proudly performed the first back in 2007.
My route into donation was via a news article, after which it suddenly seemed to be everywhere, from members of Effective Altruism, to even more news articles, to a lecture as part of my course. Now as a medical student it wasn’t as much of a coincidence as if I’d been studying English, but it still seemed like a deluge of precedent nonetheless.
Once the idea of donating a kidney no longer had the Burke and Hare ring to it, the reasoning had a chance to take hold. Dialysis, a staple of renal replacement therapy, is far from a perfect solution with some patients having a prognosis worse than some cancers. In young patients especially, the longer a patient waits before transplant the shorter their life is likely to be. Coupling this with the fact that the rate limiting step in transplantation is the supply of kidneys, then there exists a strong incentive to acquire some more kidneys.
However, transplantation does have drawbacks, including the need for anti-rejection medications. These are drugs that supress our natural immune system, preventing damage to the new organ. An unfortunate side effect is that this leaves the door open for infections to take hold much more easily. However, most recipients agree a marked increase in quality of life post-transplant and it saves the NHS tens of thousands a year per transplant.
My route to donation was rather smooth, after looking at a list much like this one I sent an email to my local unit asking for more information. This lead into meeting the excellent people of Royal Free’s Live Donor team, and a series of appointments, tests, and imaging. Essentially checking that I haven’t caused too much damage to myself over the last 23 years and deciding how likely I would be to develop a kidney-related problem in the future.
Among the requirements for becoming a live donor is a meeting with a psychologist, the purpose of which is to find out the extent of ones masochistic streak and to make sure one can cope with donation. After being declared sane and healthy enough to continue, the next hoop to jump through is a meeting with an independent assessor. The idea behind this stage is to verify that you are in fact fit both mentally and physically enough to continue, and that your doctor hasn’t been overly organ-hungry and rubber stamping.
Next came deciding just who to and how I would be getting rid of my kidney. These days most donor nephrectomies are performed laparoscopically (though keyhole incisions), with the kidney itself removed through a smaller version of a c-section scar at the belt line. Laparoscopic procedures vs the open version drastically reduce the time spent in hospital and speed up post-surgical recovery. In the end I had a robotically-assisted operation, which is similar to the standard laparoscopic procedure, only using a system like the da Vinci to help recover the organ.
As for who, there are a few approaches. Perhaps the most effective is kicking off a chain of donations, where relatives who aren’t a match promise to donate if their relative receives a kidney. While this route results in the most kidneys transplanted, unless there’s enough of a coincidence in suitability that the chain becomes a loop, a non-directed donation is sometimes needed to get it going.
As I was operating under some time constraints called university summer holidays, I chose to give directly to someone on the transplant list. While this doesn’t cause a chain to start, it does have a few advantages. Firstly it allowed me to be pickier over the actual operation date, and secondly it generally means you’re matched with someone at the top of the transplant list, which generally means it gets to someone that really needs it (not to say that everyone on the list isn’t in need!).
The few weeks leading up to operation day are some of the busiest. Initially matching is performed electronically through a set of known factors, however there’s still a need to actually mix donor and recipient blood to ensure that there’s no cross reaction. In my case there was some uncertainty as to whether there might be donor-specific antibodies, which required multiple samples over the run up. Donor specific antibodies can develop when the patient has had previous exposure to transplanted material, such as blood or organs, and the presence of such is a serious contraindication for transplant.
Operation day was remarkably straight forward. In fact the biggest challenge was waking up early enough, as I was fresh off the post-exam rush and definitely not in a morning-person phase. Arriving at 7:30, I was in surgery at 8:15 in a triumph of NHS efficiency.
The strange thing about anaesthesia is that there’s no perception of time spent. I helpfully came round positioned opposite a clock, and my drug-addled brain was quite amused by how blocks of time would just disappear. The rest of operation day was spent transferred to an inpatient ward higher up in the Royal Free monolith. As for pain, I can’t say that I was ever in real pain, mostly thanks to a nice cocktail of paracetamol, opiates, and a wonderful little device called a painbuster, which saturates the surgical site with a local anaesthetic.
My primary discomfort was shoulder pain. The carbon dioxide gas, used to inflate the abdomen to created enough space to operate, can irritate the nerves and diaphragm, causing referred pain to the tips of the shoulder. I can also say that I have a huge amount of sympathy for anyone who has a c-section, because even my mini version did enough of a number on my core stabilisers.
The following 72 hours also sees the gradual return of all ones bodily functions. I’ll try to avoid too much information, but I’m pretty safe in saying that the single greatest incentive to urinate is the prospect of being re-catheterised!
In the end after being admitted on Wednesday, I was discharged on the Friday, and to be honest I’ve had a pretty uneventful time since then. I’ve been off the pain killers for a week, and the dressings have come off. Surveying the damage, the incisions are aptly inhumanly small and it all looks rather neat.
I’m writing this almost 2 weeks after my donation, and while the recovery phase is longer than donating a pint of blood, I’ve been quite amazed by just how quickly everything reverts to normal. I’m up and about, returning to my normal daily habits, and walking the dogs. All with only a small amount of physical limitation.
In summary it has been a good experience, and I’d definitely do it again, provided I had another kidney to spare. I fully realise that it’s not a practical thing for everyone to do, but to anyone even entertaining the idea, I’d strongly urge them to think about it, and they can find out more at Give a Kidney. If only a tiny fraction of people donated we could easily fill the needs of everyone on the transplant list.